MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!

T

Daycare better than me?

Last year, when I was on call a lot and very busy at work, I couldn't get enough time with my babe.  I always wanted more, more, more.  And I still feel that way--about the time I spend with her.  But lately, I've been feeling like I just don't do enough.  When I'm home, I sometimes just want to relax--I don't always want to be doing educational activities, or practicing walking, or force-feeding her.  Sometimes I just want to be at home with her and I don't want the work that comes with it!

But because we now have a nanny who does not provide much educational content during the day, when I get home I feel that I need to do more with her.  And because she is home all day, it's always up to me to provide healthy nutritious meals that are variable enough for her that she actually wants to eat them.  I frequently don't feel that I do a good job in either of the above aspects and I wonder if I would be better off sending her to a daycare where she is exposed to learning and a variety of food and time to play outside and when we get home, we can just spend time together and cuddle and kiss and love.

I know now for a fact that if I was a stay at home mom, I would not be a good one.  I just don't have the energy it takes to provide my Doll with all that she needs!  I'm grateful for my job, and I always want more TIME with my baby, but I just want it to be quality time where I'm not stressed with her.

Does anything I'm saying make any sense?

I am starting to hate the holidays

A few years ago, I made a post that really bothered some people, suggesting that people who have small children get first picks for holidays off, because it may be difficult (or possibly impossible) for them to find childcare. Several people suggested to me that I was a… well, I don't want to use language on this blog, but let's just say a selfish female dog who should probably be fornicating with myself.

I don't want to stir the pot but I will give my experience trying to find coverage for the upcoming holidays when I will be working:

--me: working
--husband: working
--Schools: closed
--afterschool program: closed
--daycare: closed
--babysitter 1: Will be in church and at family functions
--babysitter 2: traveling for the entire holiday
--me: screwed

I'm currently putting together a piecemeal of various elderly grandparents coming by to watch the kids, and working out a plan to come to work at odd hours. It's hard, to say the least, despite the fact that I actually have a very flexible job.

I know I can't be the only one with this problem, yet it's clear that everyone feels really angry about the idea of making any accommodations for people with childcare needs. Maybe a better plan would be for there to be some sort of reliable group childcare out there for people like us (e.g. healthcare workers) who will be working at least some of the holidays. Because right now? The options suck.

I'm Thankful for a Bridge

photo credit WSMV

Three months ago, I woke up to the buzzing of news helicopters over my house. This is not a common phenomenon in my secluded suburban neighborhood. I quickly checked the news and learned that a terrible tragedy had occurred. During the night, a tanker truck full of gasoline had crashed into the bridge that connects my neighborhood to the interstate, causing a massive explosion. Only a month from retirement, the driver of the truck sadly lost his life. As I said a prayer for his family, I also said a prayer of thanks that the accident hadn't occurred during rush hour when hundreds of lives could have been lost.

Later that day, I learned that the explosion caused structural damage to the bridge. It would have to be replaced. Fixing this wasn't merely going to take days, but 3-4 months.  As the reality of being "bridgeless" sunk in, the feeling of dread deepened. This was the bridge that linked us to all the elements of our life: work, school, shopping, church. Our world was about to change. 

I normally have an 8 minute commute to work. With the bridge out, I now must take the winding back roads for 25-30 min. to get to the hospital. Getting the kids to school would take an extra hour a day. Many of you are rolling your eyes at this, as your commutes are likely much longer. However, my location is a big part of my well oiled routine that keeps me sane. 

Early in my "bridgeless state," I had a premed student who shadowed me for a couple of days. The small community hospital where I practice, isn't a teaching facility so I don’t interact with students very often, but this young lady was simply delightful. She was reapplying to medical school this year after failing to get a spot last year. She was compassionate, intelligent and her MCAT scores were higher than mine had been when I applied. I couldn't believe that she hadn't gotten in yet. 

I realized that I've been at this long enough, that I have forgotten about the angst filled years of simply trying to get into medical school. I determined to use my extra commute time, to reflect on gratitude, rather than wallow in self pity over my silly inconvenience.

I have, for the most part, kept my good attitude. While still annoying, the commute hasn't been as bad as I thought. It makes me triple check my grocery list, because there are no convenience stores nearby. And rarely do we eat out for dinner, because it takes too long to get home. The worst part has been missing extra time with my kids. My short commute usually alloys me to run home and tuck my kiddos into bed, even when I'm on call, but no so much these last few months. 

  

In this season of gratitude, I am thankful for two very simple things:

I am thankful that 17 years ago, a committee somewhere said yes to my medical school application and gave me the privilege of being a doctor. 

I am especially thankful that this morning {insert drum roll please}I drove across the NEW BRIDGE. I'm thankful to have my short commute back. I promise to never take that silly bridge for granted again.

What seemingly mundane items are you thankful for this year?

An extra cup at the Thanksgiving table

As a pediatrician-mama, I find that Thanksgiving is -- to use a timely cliche -- easy as pie. I don't have to search my mind for even the shortest moment to access my gratitude place: My child is alive and healthy (*gods, do not be tempted by this statement*). The ocean of gratitude I feel for this has no bottom. I am aware of it dozens of times in the course of my day taking care of sick children: How lucky my partner and I are. How tenuous and temporary and fragile our luck is. How we can claim no credit for this fortune. There are many, many other things I am grateful for, but even if all those other things evaporated, this one thing, this everything, would still fill me up on Thanksgiving day and every day.

Yesterday, as a pre-Thanksgiving treat, my partner came and picked me up from work so we could pick my daughter up together from school. It was a gray, cold day and little specks of icy rain were making it hard to keep my eyes open as I waited just outside the entrance of the hospital. I'm on Jeopardy call all weekend but if I'm not called in, I get to have four days with my family in front of our slightly creepy ventless gas fireplace. (Where does all that CO and CO2 go? Whatever -- pass the pumpkin pie!) So I closed my eyes and sent a surge of warmth towards each of my co-residents, wishing for their well-being and the well-being of their families. Sure, it started from a place of self interest and humor, but then it felt good and right to be sending them little non-denominational blessings in honor of the holiday. There is a special place in my heart forever for the people I am training with -- a certain affection and protective instinct and a huge folder of moments in which these people have awed and inspired me, sometimes unexpectedly.

Then my mind turned to all the families I have cared for who are without a child this Thanksgiving. The babies who never made it into the world, the babies who stayed for only a few hours or days, the babies who left this world after a long struggle in the NICU, the babies who arrived to our ED in the early hours of the morning already cold and pulseless, the children whose otherwise healthy lives were shortened by cancer or trauma, the children with chronic illness who were in and out of the hospital for months or years before a cold or stomach bug proved to be more than they or we could fight. Then I thought of all the children whose lives have been shortened by war or preventable or treatable disease or famine or -- this week especially -- by racism or homophobia or genocide or hate-motivated injustice of any kind. I thought of their parents and the huge, gaping unfairness of what they were given by luck, or the universe, or God, or just random chance, depending on what you believe. I wondered how they go on with things like Thanksgiving. Would I be able to? In Judaism, when someone dies, the thing you say to the people who love them is: zachur li'vracha. May their memory be a blessing. And so, my eyes closed against the rain, I sent this out to all the parents who have lost children: May the memory of your children be a blessing and may there still be things to be grateful for.

On the Jewish holiday of Passover, we leave a cup of wine out on the table for the prophet Elijah. The teaching is that Elijah will one day come as an unknown guest and you want to be ready to welcome him. This year at my Thanksgiving table, I'm going to leave out a cup for all the parents who have lost children, that they may know they and their children are not forgotten. That they should feel welcome back into the rhythm of ritual and community, whenever they are ready. Also, that we may never take our good fortune for granted. And that we may fight in whatever way we can to prevent parents from losing children needlessly.

Happy thanksgiving to you and yours today, from one mama to another! And a special shout out to all the mamas who are taking call today so that others can be with their families -- Thanksgiving is whenever you get home!

-Also posted at whatbeginswithm.wordpress.com

Vacation sans bebe

I read a few articles recently about Americans and vacationing. Of the only 25% of Americans who have paid vacation days, they have an average of 3.2 days left unused each year (OECD, 2013).

Unused vacation days. Not us!!! We use them all up. Zo travelled with us for the first close to 2 years of his life. However, once he was weaned and could no longer be lulled into a breast milk-induced-coma, we began planning trips without him. Many thanks to my parents and in-laws. And thanks to my cousin for letting us use her timeshare to enjoy fabulous, affordable vacations.

Here is my chronicle of our delectable and delightful second Vacation Sans Bebe, New Orleans style. I will focus on the food because New Orleans has to have some of the most amazing, creamy, luscious, sinful, gluttonous food around and there is just too much to write about (the wonderful people, the outstanding architecture, the cultures, the alcohol).

Best brunch ever - I can’t tell you how much O and I love an excellent brunch. My Sorority Sister B and her husband R who work for a major oil company in Louisiana met us at Slim Goodies. The french toast below was the best I have ever had; crispy French bread crust, fluffy middle, dusted with powdered sugar, and drizzled with syrup! Paired with mimosas that you prepare yourself (orange juice from Slim Goodies and prosecco from a neighboring restaurant they have an arrangement with), it was amazing!

(scrambled eggs, french toast, and large mimosa from Slim Goodies)

Best lunch - oooooh oooooh oooooooh. Gumbo and crawfish at Cafe Reconcile. Amazing nonprofit organization that trains local teenagers and young adults for careers in the restaurant business. Wonderful staff. Delicious food. The crawfish sauce was so complex yet not overwhelming. The grits were soft but had some substance to them and were perfectly seasoned.

(crawfish on grits, from Cafe Reconcile)

And the tie for best dinner - Bacchanal Wines and Houstons.

Bacchanal had to be one of the most fun experiences. We took a taxi into the Ninth Ward past factories and train tracks and end up in a cute neighborhood. You see a line on the corner entering a house with a big fenced in yard. You enter what may have previously been a living room, but has been converted into a wine and cheese shop. You purchase a bottle of wine, get a cheese plate (we unfortunately didn’t order one and the line was too long by the time we wanted some cheese), and go find a table. There are at least 100 people sitting and standing around. There is a live band playing in the courtyard. It is magical.

My husband and I failed on our first attempts to find a table, finally separating while he waited in the 20 person long food line and me making googly-eyes at folks with finished wine glasses taking up space. Finally, a very nice retired couple took pity on my and told me to pull up an empty chair. We sat at a candlelit table talking and drinking until they left.

And then the CHICKEN arrived.

Notice how I put that sentence on its own line. I had confit chicken that literally melted in my mouth with bok choy and a yummy carb I can’t remember. I did a little research on what confit means; it is to cook meat in oil at a low temperature (it’s not fried, it like melts away, oh goodness, soo yummy). That chicken was soo freaking good I am hungry just writing about it; the skin was crispy and perfectly salted and the chicken literally fell off of the bone and just melted in my mouth. O had a grilled tilapia that was equally divine. For dessert we had dark chocolate drizzled with olive oil and sea salt with even more wine.

(courtyard at Bacchanal Wine, image from http://fleurdelicious-nola.com accessed 11/1/2014)

Beignets - and on our last night in NOLA, we toured the city, stopping in shops. Eating. Drinking alcohol-containing beverages in plastic cups while walking (crazy that you can do that legally in NOLA). We ended the night on the banks of the Mississippi eating beignets from Cafe DuMonde with B and R. We heard approaching music as a first-line band leading a wedding party approached. As is the customary, we all stood up and joined in dancing and singing “As the Saints go Marching in” under the twinkling night sky.

Here’s to the best vacation sans bebe, NOLA, we love you bebe!

(Voodoo Tour, St. Louis Cemetery #1)

Our recommendations for excellent food in NOLA:

Slim Goodies, Cafe Reconcile (weekday breakfast and lunch only, nonprofit that does job development and career training for teenagers and young adults in the Garden District), Cafe DuMonde, Houstons, and Bacchanal Wines (get there early and just go ahead and get the darn cheese plate!).

Of note, I have no conflicts or disclosures, we went everywhere based on recommendations from friends and paid for everything ourselves. All pictures were taken by me and O unless otherwise mentioned and cited.

References:

An Assessment of Paid Time Off in the U.S. Implications for employees, companies, and the economy. Accessed Oct 16 2014.

Center for Economic Policy Research. No-vacation nation revisited. 2014. Accessed Oct 16 2014.

Work-life balance. Accessed Oct 16 2014.

MiM Mail: Middle of career life crisis

I feel like I am in the middle of a career-life-crisis.

I am a mother to an almost-3-year-old, and a 9 month old. I am an OB/Gyn. And, I love being both.

After residency, I joined a large private practice. Even after I had my son, I was fairly happy with my schedule. I worked about 3 1/2 days a week in the office, one day on call per week, and one weekend on call per month. But, I thought it was a pretty good life for an OB-Gyn. I sometimes missed holidays, wedding anniversaries, and important family events, but realized that those things came with the territory. After all, babies don't take holidays from coming into this world.

About two years ago, we moved to our home state to be closer to family. In doing so, I changed career paths. I now work as an OB hospitalist, doing about seven 24-hour shifts per month. It's a different role than I ever thought I would have. I see patients in the hospital that have no physician and take care of OB emergencies when their on call physician cannot make it to the hospital in time. In short, I still get to deliver babies and help women in emergent obstetrical issues, which is very rewarding. And, I get to have a lot of time with my children. Now, for example, when we sign up for a 2 week swimming class, I only miss a couple classes, whereas before, I would have only made it to one class. I get to go to the park, the zoo, the mall carousel, and all the daily little things that a lot of mothers in medicine have to miss out on.

I feel guilty even saying this, but when I first transitioned to this job, I definitely had to adjust to being at home so much. I felt guilty at times, because there were definitely moments when I (and my son, for that matter) felt bored. I would call my sisters and ask what they do each day with their kids. But, now, we have gotten into our groove. We have play dates, learning activities, favorite fun spots, and of course, naptime. So, before I know it, the day has passed and we are on to the next. And, just when motherhood starts wearing me out, it is time for me to go to work the next day. And, actually, it is a nice break to get away and have some career time. My 3 year old son asks every morning if I am a doctor or a mom. With this job, most days I spend "being a mom", and only some days do I spend "being a doctor".

So, what's the problem? One of the reasons I went into OB/Gyn was the hospital-office balance. I loved forming long-lasting relationships with patients that continued throughout life stages, multiple pregnancies, and through difficult diagnoses. There is something about delivering someone's baby that bonds you to them. You become important to them. It almost feels like you should be invited to sit at their table for Thanksgiving dinner. And, now, I don't have that relationship. So, I keep looking at job opportunities and wondering if I should return to private practice so that I can have relationships with my patients like I had before. The thing is, that if I make that career jump back to traditional OB/Gyn private practice, I will be giving up a lot of time that I have with my kids. So, I worry that I would end up in a "grass is not always greener" situation. I'm not as familiar with the business aspects of medicine, but to the best of my knowledge, it is difficult to keep a practice afloat (paying overhead, salaries, benefits, malpractice) in the OB/Gyn world and work only part time, so full-time it would be.

I know you guys can't decide my future. The truth is, that getting it all in writing is actually helping me process it all. But, any advice would be nice. Is it possible to have a part-time OB/Gyn practice? Should I just count myself blessed that I get so much time with my kids, even though my particular position as an OB/Gyn is not quite as fulfilling as it once was? How do I not feel guilty thinking all these thoughts?

Sincerely,
Confused mommy doc

McDonalds dilemma

For a long time, I was not willing to take any time for myself. When I had a day off, I would keep the kids home and spend the day watching them, dragging them along with me to errands and doctors appointment, and not taking any time to relax.

Recently, due to my high stress level, I've decided to compromise. When I have a day off, I keep my youngest home in the morning, then bring her to daycare for the afternoon, when she would be napping anyway. (My older daughter is in school)

Initially, this didn't work very well. She would scream and cry during the drive to daycare and be inconsolable when I left.  To the point where I would practically be crying when I left.

The daycare wasn't crazy about this arrangement either. They said it was very disruptive to have her come in and be so upset.

Finally, I had what I thought was brilliant idea. There's a McDonald's on the way to daycare, so I would stop by the McDonald's and get her a happy meal to take with her. I did remove the toy for later, but she got to have the rest of it.

And you know what? It really worked. She was so excited to bring her little happy meal to school with her, and after a couple of trials of this, she was no longer upset about my leaving.

Of course, it's never that simple.

Apparently, there are a couple of kids in the class who cry inconsolably when my daughter is eating her McDonald's happy meal because they are so jealous. The teachers have tried to arrange things so that my daughter won't share a table with them, but it makes me feel bad every time I hear about it.

It's sort of silly because it's not any kind of amazing meal. It's a few chicken nuggets, apple slices, milk, and a handful of french fries.  She doesn't even get a dessert, which many other kids have.  I mean, I have literally seen kids there eating Dunkin' Donuts donuts for breakfast.

The daycare hasn't said a word to me about it or implied that I shouldn't do this anymore. But I still feel a little bit guilty. But maybe I shouldn't worry so much about other people's kids and worry more about my own.

How Do You Discipline Your Kids- In Public?

Genmedmom here.

Last week, on my usual Thursday off, I was on kids' dropoff and pickup duty, and I had a very difficult time with pickup.

Both kids are in preschool: Babygirl, almost age 3, loves her Bright Horizons daycare/ preschool, and Babyboy, age 4, is becoming more fond of his public Special Ed preschool program, as his teacher has really connected with him. Getting them up/ fed/ dressed/ out the door is always a bit of a challenge, but manageable.

Pickups, however, are getting dangerous. And not just for me, but also for my mother, who is most often on pickup duty.

Given the timing of school dismissal, we need to pick up Babyboy first, and then swing by Babygirl's school. Since you can't leave a four-year-old in a car by themselves, he has to come in with us to retrieve his sister. For the past month or so, once inside, Babyboy finds something he wants to play with in her classroom, and won't leave. He gets obsessed with completing whatever project he's invented, like lining up the construction toys or building something with Legos. I get it, he's autistic, and tends to have these sort of OCD-like moments. If you try to stop him before he's done with whatever it is he's determined to do, he throws himself on the floor in a tantrum. A loud violent tantrum. Even when he doesn't engage in something in the classroom, when it's time to leave, he gets wild, and runs away down the hallways, laughing at me when I call to him.

Babygirl is also now commonly protesting leaving, and has thrown herself on the floor, or also run away, giggling.

All of this is totally disruptive. Not only for the kids in her classroom, but for everyone in the whole school, as my kids scream and shriek and wreak havoc. Heads pop out of doorways, teachers checking on us, kids asking what's going on. If I yell, I'm just contributing to the mayhem.

Last week was the worst for me. It was him running away, and her tantruming. We were in the hallway, me kneeling on the floor trying to dress Babygirl to go outside, as she rolled around screeching, fighting me. I gave up on forcing her into rain gear (it was pouring) and hoisted her up, flailing and screaming. Meanwhile, Babyboy was running up and down the hallways, throwing himself on the carpet and rolling around, laughing defiantly. I had to chase down my son, grab his arm, and struggle out of the building. This was while carrying Babygirl, her lunchbox, raincoat, and backback.

I lost the backpack somewhere (and didn't realize until we got home), probably when I opened the heavy door. I had to let go of Babyboy in order to open it, and as soon as I did, Babyboy bolted out, across the driveway, and into the parking lot. In the rain.

There were no cars coming at that moment, thank God. But I yelled and yelled: Get back here! You hold mommy's hand in the parking lot! It was a safety issue. I had to get him and us out of the driveway and the parking area, and into the car. I yelled, I threatened, but he would not cooperate. Then Babygirl hurled herself down and I had to wrestle her back up, while attempting to run after a defiantly giggling Babyboy. The more I yelled, the worse he got. I caught him, and fairly dragged him to the car.

Finally, I jammed Babygirl into her seat and buckled her in- safe at least! And threatened to do the same for Babyboy. He got in his seat.

I was fairly shaking by the time I got into my seat. My throat hurt from yelling so much. It was so embarassing... What do the teachers think? What do other parents think?

"You both were very bad today," I admonished. I wasn't sure what else to do. They're in the car, so can't do a time-out. I'm not sure a delayed time-out would be helpful. I think spanking solves nothing, and would look awful in public as well!

They've been much the same for my mother all this week. So me, my husband, and mother have talked about this. We're struck with the difference between the kids when they're together, and when they're apart. One-on-one, they're little angels. Barring hunger or naptime, when it's just one by themselves, they're model citizens.

And, occasionally, they're OK together. I've taken both kids to restaurants, just me and them, and they've been wonderful. Random elderly women have complimented us: "Good as gold!" "So nice to see such good behavior!"

We can't figure out why Babygirl's school pickup has become such a trigger for terrible behavior. Sibling rivalry, like, they're competing for attention? Normal toddler/ preschooler defiance, like,as their sense of self forms and they're establishing independence?

We have consulted with a child psychologist in the past, and we will again. But I know there's alot of experience out there. Anyone else sometimes struggle to control their kids in public? What sort of discipline tactics work?

Genmedmom

Guest post: United we stand, divided we fall

Editor's note: MiM contributor juliaink came across this blog post and thought it would make a good guest post here. The author was gracious in sharing it with us.


I was going to write about how new parents need to come together to create a “united front” when it comes to how they’re going to raise their baby, but because of a great thread I’m following on Facebook, my focus is beginning to soften and is more inclusive. There is a need for new parents to really hash out all the key points on how you intend to raise your children – before the baby arrives. If there are any big differences in your parenting styles, it would be best to know before your little person comes into the world to shine a spotlight on them! And if there are challenges between the generations, and there almost always are, it’s important for the couple to unite together for the sake of their own relationship. If a particular issue with a grandparent comes up, their child should speak directly to them about it – not the in-law child. This is just basic information that you’ve probably already figured out as a couple, but has special importance when you become new parents.

Having acknowledged all of this, the thread I’m following on Facebook talks about how grandmothers might experience postpartum mood disorders as their own daughters become pregnant and give birth. This was nothing I’d ever considered before, but makes complete sense to me upon hearing it. What a woman experiences during her birth will remain with her for always, her whole life. As a woman’s own daughter begins her journey toward motherhood these emotions and feelings from so long ago might begin to resurface. This can cause strain in the mother/daughter relationship as the soon-to-be grandmother revisits her own experience. If it was negative or traumatic for her, than there will be challenges that come along with this remembered event. If there were no real issues at her birth, there can still be some challenges or feelings of judgement if her daughter decides to do things differently from the way she did in her early years of mothering.

The same can be said for fathers and grandfathers. We live in a very different time with new research and lots of ideas about best practices during pregnancy, birth and parenting that just simply did not exist when our own mothers and fathers were on their journey. It’s no wonder that we have plenty of families having discussions with soundbites like this:

“When we were having babies, we just did it! What are you so worried about?”

“Well, that’s not the way we did it when you were a baby, and you turned out just fine, didn’t you?”

The health care system I work for has a fairly new class called “Grandparents Today” and it’s geared toward softening these conversations between the generations. It’s taught by a retired L&D nurse of 35 years on the floor who also happens to be a grandmother herself, so this is peer-to-peer education. The class brings to light all of the current information we have on how to keep babies safe when sleeping, why there is such an emphasis on breastfeeding, how and why it makes such good sense to wear your babies and have them skin-to-skin as much as possible, etc. The grandparents who take this class absolutely love it! They come back to their own children and school them about these best practices and everyone lands on the same page – at least about the things that are taught in the class.

I’d like to propose these two generations take this opportunity of bringing the newest family member on board as a chance to unite the whole family around raising this little person to adulthood. It’s a ton of work to do this job well – if you’re lucky enough to have your parents nearby and can count on them to assist with the day-to-day care of your newborn, this can be a lifesaver for you and your relationship. But even if they’re far away, relying on the wisdom that they possess – just from having more years on this earth than you – can be so helpful.

When talking with them about your challenges, try hard not to compare your situation to theirs. Yes, you might be going back to work full-time and they stayed home, but every parent works – just in different locations! Include your father in this new stage of his life without resentment – it was a different time and he was not encouraged to take part in parenting the same way you are today. If your mother never breastfed you, remember that as she’s learning right along with you, her words don’t mean to be unsupportive, she just might be feeling a little guilty about not doing this when it was her turn.

Having a new baby means stretching, growing and making room for this little person. Everyone examines who they are in relationship to this new life and it brings up stuff for each member of the family, some of it good and some of it not so good. Don’t assume anything in communication with one another. If the words you hear sting, instead of getting defensive, pause and try to imagine where their hurt might be coming from. Ask lots of questions. Look for understanding and common ground.

Having a baby does not have to be something that divides a family – it can be something that brings you all together. Being aware of these multi-generational challenges can be one way that you get closer to your own parents. Isn’t that something worth fighting for?

When you had your baby, did issues arise between you and your own parents? How did you handle them? Did the baby bring you closer together or drive you farther apart?


-Barb Buckner Suárez, a childbirth educator
Originally posted at Birth Happens

MiM Mail: Residency limit for leave and having children

First of all, thank you for this amazing blog that provides me with so much inspiration. It's so nice to hear from other women at all stages of training on their struggles and triumphs.

I'm specifically looking for anyone out there who had a baby during an anesthesia residency program. I'm hoping to have #2 while still in residency, but the ABA states that no one can take more than 20 days of leave per year during residency without making up the time. I know, based on my first little one (had during med school), that I will need at least 8 weeks, ideally 10. But I'm also poised to do a fellowship! Has anyone gone through this and found a loophole? Or convinced a fellowship program to let them start a month or two late? I feel that if we wait until I'm an attending, the age gap between our little ones will be too big (7 years).

Thanks in advance for your help!

The New Four Fs

Last year, I spent a couple of months doubled over with post-prandial pain after dinner. We’re talking pain that would sometimes incapacitate me, having to lie down while my husband tended to the kids and got them ready for bed. I’ve been lucky to be generally healthy so this was a fairly disturbing turn of events—was I now starting to fall apart physically as I neared 40?

It turned out to be a gallstone. A single but determined gallstone: too large to pass, too much of a drama queen to peacefully co-exist in my right upper quadrant. Of course, I remembered that mnemonic from medical school about the Four Fs of risk factors for cholesterol gallstones: Fat, Female, Fertile, Forty. This did not improve my “downhill” meme. As a 23-year old medical student, hearing that mnemonic involving 40 was downright depressing. That was my future: declining bone mass, fertility, metabolism and physical health. Awesome!

Back to those fun months of pain, I was given a referral to see a surgeon. I made a joke about the Four Fs and my meeting multiple risk factors. He shot me down, “Those are not true.” Hmmm. Apparently I never got the updated gallstone mnemonic memo.

Having recently crashed the “now 40” party, I have decided that I will ascribe to a new 4 Fs system going forward:

Fit, Fearless, Fabulous, Forty.

Fit. I am fitter than I have been in years. Sure, I don’t have the time or will to work out daily like in college and medical school (and probably that was a little pathologic anyway), but I have been consistently exercising about three times a week. I rarely have enough time (or will – time is not the only barrier) to do more than 30 minutes at a time, but I’m really proud of sticking to a routine even if I am traveling. My body is not built for running long or hard but it can do 2-3 miles if gently prodded without disintegrating into a rubble of bone fragments. As a family, we’ve taken to going to the nearby high school track on the weekend so the kids can ride bikes, run, or play while I do my laps. I have no lofty aspirations of marathons or anything of that high-achieving jazz but to stay committed to regular exercise for stress relief, brain preservation, and of course all of the physical benefits.

Fearless. I have had plenty of fear and anxiety in my life. Do they like me? What if I say the wrong thing? Who is that man on the bike path? What if I get pregnant? What if I don’t get pregnant? Why didn’t my husband call me at the agreed-upon time during his deployment? Etc etc. My goal now is to be more mentally strong. Easier said than done, but I think understanding myself better, having more internal security in who I am is the key – and that’s happening as I get older. I’m not trying to morph into a daredevil risk-taker (although, I did recently swing on a rope, suspended in the air by a cable, into a large aerial web of rope and climbed spider-style onto the adjoining tree platform – THAT was fun), but to doubt myself less, believe more. That brings me to the next F.

Fabulous. Fabulous is not just how you look but also a state of mind. It’s feeling amazing and worth it. I have outfits that make me feel fabulous. I have work that I engage in (particularly involving education, research and leadership) that I know I have talents for and thus makes me feel fabulous. Being able to make my family (children and husband included) individually and collectively feel loved and important = more fabulousness. No one can feel fabulous all the time, but doing things that make me feel this way as much as possible is my goal.

Forty. Forty is nowhere near downhill. I feel like I am at my height as a mother, as a contributing member of society, as a partner, as a physician, as a human. I would not want to trade places with my 20-year old or 30-year old selves, even if she did have higher bone mass, faster metabolism and better skin. I have come so far! (Products also help, skin-wise.)

So those are my new Four Fs. What would be yours?

Go vote!

Last week I got off early and took my 'lil bit with me to vote (aka "bote" according to her).  This is the second time in her little life that she's come with me to our local library to get her "Merican flag" sticker.  Now that she's almost 4 we had a little lesson on the drive over about how girls and people with brown skin like us didn't get to vote a long time ago.  She was adoringly APPALLED!  She said that the people who don't let girls and brown people "bote" were not acting "nicely." I agreed.  So, today, for all us moms in medicine who are walking paths blazed by amazing women before us - HAPPY VOTING DAY!!

MiM Mail: Types of practices and family life

Hello fellow Mothers in Medicine!

I am a senior resident in a medical subspecialty, about to graduate next year, and am in need of frank advice on different types of practices and having a full family life. I have a child under the age of 1, and plan on having a second child within the next few years. My specialty allows for some flexibility, and I think that either solo practice, small private practice, or hospital employment are all viable options. Ideally, I would like to work part time while my children are young. I am hoping to gain some perspectives on others experiences with the varying different practice types, what worked well for young families and what presented challenges. Thank you in advance for sharing your experiences and thoughts!

Guest post: It takes a village . . .

...and my village includes a housecleaner, a nanny, a back-up part-time nanny for on-call days, an amazingly flexible husband who works from home and one amazing non-medical friend I've made in this new city. Plus, in really important crunch times, a family willing to fly across the country for weeks at a time to care for my family so I can focus on studying. I come from a family whose resources definitely did not allow for hiring nannies or housecleaners, so I always feel a little self-conscious about it and hesitate to seek help, even when I know it’s needed.

Before medical school, and even during the first two years, I could usually balance the work of school with the work of home. Between studying for Step 1 and then starting 3rd year, with two young children, I realized something had to give! I finally accepted the fact that extra help was necessary, for my sanity and for my success in medicine. While I don't mind cleaning the tub or mopping the floor, I would rather spend that time playing with my children, hanging out with my husband, trying to maintain some relationship with my friends and family, and of course, reading, reading, reading for school!

Since I've relinquished control of keeping up with the cleaning, and since my husband has taken over the cooking (mostly), I'm amazed how much time and mental energy I've been able to devote to school. I'm also pleasantly surprised at how much this extra time to study has boosted my confidence on the wards and subsequently my performance. Meanwhile, at home, I'm actually more likely to tidy up and clean a bit every day, since I don't feel so overwhelmed with the amount of cleaning to be done. This makes my husband, a neat freak by nature, extremely happy. Historically, every woman who could afford to hired people to help manage the house, so why do we try to be superwomen today?

I'm interested to hear how other mothers in medicine have found ways to expand their village of support and if they noticed a difference in their professional lives. I’m also interested to hear if you received any negative responses from your family about hiring help?

Ley is a medical student with two children under age 5. She lives on the west coast and remembers enjoying running, cycling and camping before medical school happened; she hopes to return to those hobbies sometime in the next decade.